主动脉球囊反搏最新临床研究回顾

主动脉球囊反搏（IABP）已在临床使用数十年,但一直缺乏相关的随机临床试验证据,既往相关的研究多为非随机试验及观察性研究。在最近几年内,IABP相关的多中心随机临床实验结果相继发表,然而研究结果却与普遍理解的IABP应有的生理方面获益不相符。在急性心肌梗死合并心源性休克、ST段抬高性心肌梗死不伴休克及高危经皮冠状动脉介入治疗中,使用IABP辅助均未达到实验预期的结果。但在这些研究中使用IABP有长期获益的趋势,且实验结果提示对于部分患者,选择使用IABP可以得到临床获益且得到较好的血流动力学支持。表明对于IABP的进一步评估和临床研究应该以患者为中心制定个性化治疗方案,且使用应达到最大的生理获益。现就最近几年IABP相关的随机临床实验予以综述。     

主动脉内球囊反搏的临床应用现状和进展

主动脉内球囊反搏泵(IABP)通过主动脉内球囊在心脏舒张期快速充盈和收缩期快速排空的方式,改善冠状动脉血流灌注,同时降低心脏后负荷及心肌耗氧量。现广泛应用于急性心肌梗死合并心原性休克、血流动力学不稳定的高危经皮冠状动脉介入治疗等临床情况,取得了较好的临床疗效,但最新一些临床研究结果却得出了不同的结论,部分学者对IABP的临床应用有不同的意见及争论。当IABP主要的传统适应证面临极大的挑战时,而其潜在的适应证在临床中相继报道,IABP的适应证范围正逐步扩大,可能是未来IABP临床应用的发展方向。现就IABP临床应用的现状与进展做一综述。     

主动脉内球囊反搏泵的临床应用进展

主动脉内球囊反搏泵（IABP）是一项临床上常用的治疗手段,现已广泛应用于急性心肌梗死合并心源性休克、血流动力学不稳定的高危经皮冠状动脉介入治疗、冠状动脉旁路移植术等临床情况。最近一些研究对IABP的应用提出质疑,但我们综合分析认为IABP的应用是有价值的。     

主动脉内球囊反搏技术救治高危冠状动脉旁路移植术患者

目的探讨围手术期应用主动脉内球囊反搏（intra-aortic balloon pump,IABP）对高危冠心病患者冠状动脉旁路移植术（coronary artery bypass graft,CABG）患者救治的效果。方法回顾性分析IABP对42例CABG围手术期患者的临床反应、血流动力学以及病死率的影响。结果平均IABP辅助时间（87±16）h,辅助期间平均动脉压（MAP）明显升高,心率降低、心排血量指数增加,术中及术前使用可改善心脏不停跳冠状动脉旁路移植术过程中,心脏对稳定器压迫的耐受性,同时使心脏功能差的患者顺利脱离体外循环。34例康复出院,住院死亡8例,主要死亡原因为低心排血量综合征、多器官功能衰竭等。结论IABP是一种简单有效的循环辅助手段,心功能差的高危CABG患者应积极地放置IABP。     

预防性置入主动脉内球囊反搏应用于高危冠心病行冠状动脉旁路移植术患者的临床疗效分析

目的 探讨预防性置入主动脉内球囊反搏(intra-aortic balloon pump,IABP)在高危冠心病患者接受冠状动脉旁路移植术(coronary artery bypass graft,CABG)中的临床疗效.方法 回顾并总结我院2013年1月至2020年6月175例CABG围术期行IABP置入术患者的临床...     

预防性置入主动脉内球囊反搏应用于高危冠心病患者行冠状动脉旁路移植术临床疗效分析

目的 探讨预防性置入主动脉内球囊反搏（Intra-aortic balloon pump ,IABP)在高危冠心病患者接受冠状动脉旁路移植术（Coronary artery bypass graft,CABG）中的临床疗效。方法 回顾并总结我院2013年01月-2020年06月175例CABG围术期行IABP置入术患者的临床资料,术前平均年龄（61.2±9.2）岁,其中男性131人（74.9%）。根据IABP置入时机分为预防性置入组（术前置入IABP）（n=66）和对照组（术中或术后置入IABP）（n=109）,对比分析两组患者临床资料。结果 两组患者一般基线资料差异无统计学意义（P>0.05）。与对照组相比,预防性置入组IABP支持时间（h,107.5±68.3 vs 130.4±72.6）,机械通气时间（h,76.9±82.1 vs 129.6±160.5）,ICU监护时间（h,145.9±99.9 vs 196.4±180.5）显著减少（P?0.05）。术后急性肾损伤（13.6% vs 28.4%）、低心排量综合征（0 vs 6.4%）、多器官功能衰竭（0 vs 7.3%）发生率降低,差异有统计学意义（P?0.05）。预防性置入组围术期死亡率（10.6%）低于对照组（22.9%）,差异有统计学意义（P?0.05）。结论 对于接受CABG治疗的高危冠心病患者,术前预防性置入IABP可降低患者围术期死亡率,降低术后急性肾损伤、低心排量综合征、多器官功能衰竭发生率,缩短IABP支持时间、机械通气时间、ICU监护时间。     

主动脉内球囊反搏在高危冠心病中的应用

主动脉内球囊反搏是目前应用最广泛的心脏辅助装置之一,本文就主动脉内球囊反搏的作用机制,在不同病变中对冠状动脉血流的影响,以及作为辅助和过渡治疗,在各种高危冠心病中的临床应用作一简要综述.     

主动脉内球囊反搏在高危冠心病中的应用

主动脉内球囊反搏是目前应用最广泛的心脏辅助装置之一,本文就主动脉内球囊反搏的作用机制,在不同病变中对冠状动脉血流的影响,以及作为辅助和过渡治疗,在各种高危冠心病中的临床应用作一简要综述。     

主动脉内球囊反搏在冠状动脉旁路移植术中的应用

主动脉内球囊反搏(IABP)作为抢救术后低心排综合征(Low card iac output syndrom l,LCOS)的一项治疗措施越来越广泛地应用于临床。1998年6月~2005年6月我院为40例冠状动脉旁路移植术(Coronary artery bypass grafting,CABG)患者行IABP辅助循环,收到满意效果,现报道如下。1临床资料40例IABP患者中,男34例,女6例,年龄45~75岁,术前心肌缺血或急性心梗25例,左心室射血分数(ejectionfraction,EF)34%~83%,搭桥数目为1~5条,主动脉阻断时间为98~265m in,体外循环时间为171~610m in,IABP时间为14~210 h。采用股动脉切开或直接穿刺,利用导…     

冠状动脉旁路移植术围手术期主动脉内球囊反搏应用时机的临床体会

目的:探讨高危冠状动脉旁路移植术(CABG)患者应用主动脉内球囊反搏治疗(IABP)时机的选择问题.方法:对54例高危CABG患者应用IABP的情况进行回顾性分析,比较术前预防性应用组与术中及术后循环状态不稳定情况下应用组的总体病死率、IABP使用时间、机械通气时间、患者住ICU时间及血管活性药物使用情况.结果:术前预防性应用组病死率降低,机械通气时间、患者住ICU时间及血管活性药物使用剂量均显著低于术中及术后应用组.结论:对高危CABG患者预防性应用IABP能够降低围术期病死率,改善患者预后.     

Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention

Intra-aortic balloon pump (IABP) has been shown to support patients who are at high risk for percutaneous coronary interventions (PCIs) or becoming hemodynamically unstable during PCI, but the longer term outcomes of these strategies are unknown. This study investigated the outcomes of high-risk patients who received a prophylactic IABP (P-IABP) versus patients who required rescue IABP (R-IABP) because of intraprocedural complications. Clinical outcomes of 68 consecutive patients (69 procedures) who underwent high-risk PCI with P-IABP support were compared with those of 46 patients who required R-IABP. Patients who presented with cardiogenic shock or acute ST-segment elevation myocardial infarction, and those who were on mechanical ventilators were excluded. Clinical baseline characteristics were similar between groups except for more diabetics and patients with hypercholesterolemia in the P-IABP group. The procedural success was higher in the P-IABP group, with lower in-hospital mortality and major complications, than in the R-IABP group. At 6 months, the mortality and major adverse cardiac event rates were lower in the P-IABP group (8% vs 29%, p < 0.01, and 12% vs 32%, p = 0.02, respectively). Multivariate analysis showed that prophylactic insertion of an IABP is the only independent predictor of survival at 6 months. The incidence of vascular complications was low and comparable except for more major bleeding (15% vs 3%, p = 0.03) in the R-IABP group. In conclusion, patients who undergo high-risk PCI and then receive P-IABP support have favorable outcomes compared with those who require R-IABP for intraprocedural complications. Therefore, in high-risk patients undergoing PCI, liberal use of a P-IABP should be considered.     

主动脉内球囊反搏在高危冠心病患者中的运用

目的探讨主动脉内球囊反搏（IABP）在高危冠心病患者治疗中的作用。方法回顾性分析2002年1月至2008年6月,运用IABP治疗69例高危冠心病患者的经验。结果在IABP辅助下,有43例患者接受了经皮冠状动脉腔内介入治疗（PCI）,14例进行了冠状动脉旁路移植术（CABG）,保守治疗12例。52例好转或痊愈;病死17例,其中冠状动脉再血管化治疗前死亡6例。结论IABP可为高危冠心病患者进行下一步治疗,如PCI和CABG,赢得有效时机,并提高患者围术期的安全性和手术成功率。     

Haemodynamic and antiischaemic protective effects of intra-aortic balloon counterpulsation in high risk coronary heart patients undergoing percutaneous transluminal coronary angioplasty

Sixteen critically ill atherosclerotic cardiac patients required intra-aortic balloon counterpulsation (IABP) for uncontrollable chest pain, hypotension or shock in connection with percutaneous transluminal coronary angioplasty (PTCA). 1.75 coronary artery angioplasty/patient were attempted. An angiographic and an immediate clinical success was achieved in 27 out of 28 attempts (96% primary success rate). All patients received heparin and antiplatelet agents. After PTCA, haemodynamic stabilization was achieved and IABP support was stopped in 14 to 96 hours. The percutaneous therapeutic procedures were well tolerated. Three patients died: one of cerebrovascular accident not related to cardiovascular problems, two other patients died suddenly 1 and 3 months later. Two patients required coronary bypass surgery, one a repeated angioplasty on a reoccluded left anterior descending saphenous vein bypass. 12 of the 13 survivors are asymptomatic after a 15-months follow-up period. IABP is a useful adjunct to PTCA in patients with severely damaged coronary circulation and compromised haemodynamics.     

Transbrachial intra-aortic balloon pumping for high-risk percutaneous coronary intervention

The beneficial effect of placement of intra-aortic balloon (IAB) pump before revascularization in patients with high-risk coronary anatomy and impaired left ventricular systolic function is documented. However, the conventional insertion of IAB pump via the common femoral artery may be contraindicated or may be even impossible in patients with severe vascular disease. Recently, the percutaneous insertion of IAB via the brachial artery has been shown to be effective and safe in small series of patients with vascular disease undergoing coronary artery bypass surgery. The authors report their experience with a patient with aortobifemoral bypass grafts who underwent successful stenting of a trifurcating distal left main stenosis after placement of a 7.5-Fr IAB pump via the left brachial artery.     

Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction

Background

Little evidence is available on the optimal sequence of intra-aortic balloon pump (IABP) support initiation and primary percutaneous coronary intervention (PCI) in patients who present with cardiogenic shock from ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the order of IABP insertion and primary PCI and its association with infarct size and mortality.

Methods

A series of 173 consecutive patients admitted with cardiogenic shock from STEMI and treated with primary PCI and IABP between 2000 and 2009 were included. The order of IABP insertion and primary PCI was left at the discretion of the interventional cardiologist.

Results

All baseline characteristics were similar in patients who first received IABP (n = 87) and patients who received IABP directly after PCI (n = 86). In these two groups, cumulative 30-day mortality was 44% and 37% respectively (p = 0.39). Median peak serum creatine kinase (CK) concentrations were 5692 U/l and 4034 U/l respectively (p = 0.048). In multivariable analysis, IABP insertion before PCI was independently associated with higher CK levels (p = 0.046). In patients who survived 30 days, IABP insertion before PCI was not associated with late mortality evaluated at five years of follow-up (HR1.5, 95% CI 0.7–3.3; p = 0.34).

Conclusions

Early IABP insertion before primary PCI might be associated with higher peak CK levels, indicating a larger infarct size. A possible explanation may be the increased reperfusion delay. Our study suggests that early reperfusion could have priority over routine early IABP insertion in STEMI patients with cardiogenic shock. Randomized studies are needed to determine the optimal timing of IABP insertion relative to primary PCI.     

主动脉内球囊反搏辅助老年急性冠脉综合征患者介入治疗临床疗效分析

目的评价老年急性冠脉综合征(ACS)患者在主动脉内球囊反搏(IABP)辅助下进行介入治疗的临床疗效及安全性。方法回顾性分析160例ACS患者在IABP辅助下行介入治疗的临床资料,按年龄分为两组:中青年组(年龄<60岁)58例,老年组(年龄≥60岁)102例。对两组的手术成功率、住院期间不良事件及IABP相关并发症进行对比分析。结果两组手术成功率分别为98.3%,97.1%;院内存活率分别为89.7%,83.3%;IABP相关并发症发生率分别为3.4%,5.9%。上述差异均无统计学意义(P>0.05)。结论IABP辅助介入治疗老年ACS患者具有与中青年ACS患者应用时相似的临床疗效及安全性。     

Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: Vascular complications and incidence of bleeding

Objective: Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI).

Background: Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use.

Methods: Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared.

Results: Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively (P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia (n = 1) and aortic rupture (n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups.

Conclusion: Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring.     

Bilateral arm approach for percutaneous coronary intervention of unprotected left main supported by a modified intra-aortic balloon pump

Patients in whom femoral arterial access is not feasible pose a challenge in terms of hemodynamic support during high-risk percutaneous coronary intervention. Patient's height adds another challenge given the fixed lengths of available intra-aortic balloon pumps, in terms of achieving an adequate infrasubclavian positioning in the descending thoracic aorta. We report a case where a modified intra-aortic balloon pump helped achieve a successful result in a patient undergoing intervention of an unprotected left main using bilateral arm approach.